Healthy PA prioritizes able-bodied adults over the truly needy by paying higher reimbursement rates to doctors that treat Healthy PA enrollees through ObamaCare exchange plans. The most vulnerable citizens, on the other hand, remain in a largely broken Medicaid system with lower reimbursement rates, making it even more difficult to access a medical provider as they compete for access with this new expansion population.

This is already happening in Arkansas, where state officials report that some providers are moving able-bodied adults to the front of the line and kicking the truly needy who remain in Old Medicaid to the back. This access problem could be acute in Pennsylvania as already 59 of the 67 counties are classified as primary care shortage areas by the federal Health Resource and Services Administration.

Healthy PA is not fiscally responsible.

Rhetoric: Healthy PA will bring in lots of “free” federal money. And if the federal government reduces its share in the future, Pennsylvania can pull out of expansion.

Reality: Healthy PA introduces incredible budget uncertainty. The Medicaid program in Pennsylvania is projected to cost taxpayers $40.9 billion per year by 2022without expansion, up from $24 billion today. Gov. Corbett is right to point out this path is unsustainable, but his ObamaCare Medicaid expansion plan will make this situation worse, not better.

Expanding Pennsylvania’s traditional Medicaid program will add an extra $41 billion in new costs to the program during the first nine years. The open-ended entitlement design of Healthy PA could result in even higher costs, as the Congressional Budget Office and other actuaries predict expanding coverage through ObamaCare exchange plans will be far more expensive than expanding through traditional Medicaid.

Taxpayers simply cannot afford to create a new welfare entitlement for working-age, able-bodied adults when the nation is already $17 trillion in debt, not including the unfunded liabilities owed for existing entitlements such as Medicare and Social Security. When the federal government ultimately reduces its promised funding, which President Obama himself has already attempted in several budget proposals, it will be unlikely that Pennsylvania will be able to opt out of the expansion.

Federal law classifies this new expansion population of able-bodied adults as a “mandatory” population for states that choose to expand Medicaid, meaning the federal government could withhold all Medicaid funding if Pennsylvania tries to end its expansion after opting into it. Also those losing coverage are likely to have standing to challenge the expansion reversal in court.

Put simply, Healthy PA creates a new entitlement for able-bodied adults, which will likely mean making this new welfare program expansion a permanent liability, even if the federal government breaks its financial promise.

For context, even a 10 percent reduction in the federal contribution for the expansion population would result in a 156 percent hike in Pennsylvania’s required contribution. President Obama’s “blended rate” proposal in his budget to fund Medicaid would result in a 300 percent increase in Pennsylvania’s Medicaid expansion costs. This is something the Commonwealth simply cannot afford as it faces a budget shortfall well over $1 billion.

Reality: Gov. Corbett has already ceded to federal pressure by watering down the work search requirement provisions in earlier versions of Healthy PA. The provision now basically amounts to a “ search” requirement for many enrollees. Almost all work related activities listed in the waiver are optional. The waiver also allows for numerous exemptions from the requirements and leaves the door wide open for case-by-case exemptions for an ill-defined “crisis” or “temporary condition or situation” that prevents an enrollee from “searching” for work.